谷丙转氨酶正常未接受抗病毒治疗的慢性乙型肝炎患者临床及病理学特点分析  

Clinical and pathological characteristics of chronic hepatitis B patients with normal alanine aminotransferase and not receiving antiviral therapy

作　　者：刘世恒 李文聪[1] 张莹[1] 李静[1] 任伟光[1] 韩芳[1] 张潇潇 赵素贤[1] 南月敏[1] Liu Shiheng;Li Wencong;Zhang Ying;Li Jing;Ren Weiguang;Han Fang;Zhang Xiaoxiao;Zhao Suxian;Nan Yuemin(Department of Traditional and Western Medical Hepatology,the Third Hospital of Hebei Medical University,Hebei Provincial Key Laboratory of Hepatic Fibrosis Mechanisms in Chronic Liver Diseases,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院中西医结合肝病科,河北省慢性肝病肝纤维化研究重点实验室,石家庄050051

出　　处：《中华微生物学和免疫学杂志》2023年第7期534-540,共7页Chinese Journal of Microbiology and Immunology

基　　金：河北省重点研发计划项目民生科技专项(19277779D);河北省引进留学人员资助项目(C20210507)。

摘　　要：目的分析谷丙转氨酶(alanine aminotransferase,ALT)正常且未接受抗病毒治疗的慢性乙型肝炎(chronic hepatitis B,CHB)患者临床和病理学特点。方法回顾性纳入2008年1月—2022年12月于河北医科大学第三医院中西医结合肝病科经肝穿刺病理诊断的CHB患者,将纳入的研究对象按照"免疫耐受期、免疫控制期"的HBV DNA、HBeAg状态分为慢性HBV携带状态组、非活动性HBsAg携带状态组以及不符合上述两组的不确定期组。计量资料多组间比较采用Kruskal-Wallis H检验,两组间的比较采用Mann-Whitney U检验。计数资料采用χ^(2)检验或Fisher确切概率法进行组间比较。有序分类资料的比较采用Mann-Whitney U检验。结果共纳入284例ALT正常且未接受抗病毒治疗的CHB患者,其中慢性HBV携带状态组64例、非活动性HBsAg携带状态组88例、不确定期组132例。284例CHB患者中肝组织病理炎症分级(inflammation grade,G)且(或)纤维化分期(fibrosis stage,S)≥2者182例(64.08%),S≥2患者155例(54.58%),G≥2患者120例(42.25%)。不确定期组患者G且(或)S≥2的比例[70.45%(93/132)]高于慢性HBV携带状态组[48.44%(31/64)]和非活动性HBsAg携带状态组[65.91%(58/88)](P均<0.05)。慢性HBV携带状态组患者的年龄和S≥2比例[33岁,39.06%(25/64)]均低于非活动性HBsAg携带状态组[39岁,56.82%(50/88)]和不确定期组患者[39岁,60.61%(80/132)](P均<0.05)。非活动性HBsAg携带状态组患者的ALT水平(19 U/L)低于慢性HBV携带状态组(26 U/L)和不确定期组患者(23 U/L)(P均<0.05)。在284例CHB患者中,G且(或)S≥2的患者HBcAg胞质/胞质胞核表达型的比例高于G且S均<2的患者[73.08%(57/78)比32.08%(17/53),P<0.05];并且随着年龄的增加,胞质/胞质胞核型比例逐渐上升。在慢性HBV携带状态组和不确定期组中,G且(或)S≥2的患者HBcAg胞质/胞质胞核表达型的比例均高于G且S均<2的患者[93.33%(28/30)比43.33%(13/30);59.46%(22/37)比12.50%(2/16);P均<0.05]。�Objective To analyze the clinical and pathological characteristics of chronic hepatitis B(CHB)patients with normal alanine aminotransferase(ALT)and not receiving antiviral therapy.Methods This study retrospectively included CHB patients diagnosed by liver biopsy at the Third Hospital of Hebei Medical University from January 2008 to December 2022.According to the HBV DNA and HBeAg status of"immune tolerance period and immune control period",these patients were divided into three groups:chronic HBV carrier group,inactive HBsAg carrier group and indeterminate group including the patients that did not meet the inclusion criteria of the above two groups.Kruskal-Wallis H test was used for comparison of continuous data between multiple groups.Mann-Whitney U test was used for comparison of continuous data and ordered categorical data between two groups.Chi-square test or Fisher′s exact test was used for comparison of categorical data between two groups.Results A total of 284 CHB patients with normal ALT were enrolled.There were 64,88 and 132 cases in the chronic HBV carrier group,inactive HBsAg carrier group and indeterminate group,respectively.Histopathological analysis revealed that there were 182(64.08%)cases with pathological inflammation grade(G)and/or fibrosis stage(S)≥2,155(54.58%)with S≥2 and 120(42.25%)with G≥2.The proportion of patients with G and/or S≥2 in the indeterminate group[70.45%(93/132)]was higher than that in the chronic HBV carrier group[48.44%(31/64)]and inactive HBsAg carrier group[65.91%(58/88)](both P<0.05).Patient′s age and the ratio of patients with S≥2 in the chronic HBV carrier group[33 years old,39.06%(25/64)]were smaller than those in the inactive HBsAg carrier group[39 years old,56.82%(50/88)]and the indeterminate group[39 years old,60.61%(80/132)](all P<0.05).Patients in the inactive HBsAg carrier group(19 U/L)had lower ALT levels than those in the chronic HBV carrier group(26 U/L)and the indeterminate group(23 U/L)(both P<0.05).The proportion of patients with cytoplasmic/cy

关 键 词：乙型肝炎 谷丙转氨酶 免疫状态 HBCAG 

分 类 号：R512.62[医药卫生—内科学]